Eliminating Routine Maternal Blood Work After Cesarean Birth: A Quality Improvement Project.

Area of Science:

• Obstetrics and Gynecology
• Laboratory Medicine
• Healthcare Quality Improvement

Background:

• Routine laboratory testing, such as maternal complete blood count (CBC) post-cesarean birth, contributes to healthcare inefficiencies and waste.
• Current practices often involve unnecessary postpartum CBC testing that does not alter clinical management for most patients.

Purpose of the Study:

• To decrease routine postpartum CBC testing after cesarean delivery.
• To implement targeted ordering criteria for postpartum CBCs based on risk factors for severe anemia.

Main Methods:

• A quality improvement intervention using two plan-do-study-act (PDSA) cycles was implemented at a tertiary-care hospital.
• Electronic order sets were modified, and specific criteria (hemoglobin levels, blood loss, operating time) were established for CBC ordering.
• The primary outcome measured was the proportion of postpartum CBC draws, evaluated using run charts.

Main Results:

• The postpartum CBC draw proportion decreased from 99% to 34% during the intervention (n=202).
• This reduction remained stable at one year post-intervention.
• The detection rate of severe anemia (≤70 g/L) was unchanged (2.4% vs. 2.3%, p=0.88), with no reported anemia-related symptoms in patients who met criteria but did not have a CBC draw.

Conclusions:

• The quality improvement intervention successfully achieved a significant and sustained reduction in postpartum CBC ordering.
• Targeted ordering criteria can effectively decrease low-value laboratory testing without compromising the identification of severe anemia.
• Hospitals should consider adapting similar initiatives by modifying ordering criteria to align with local clinical trends and needs.